Transcript Accelerating TB/HIV activities in Zambia

Accelerating TB/HIV activities
in Zambia
Alwyn Mwinga
2007 HIV Implementers Meeting
20 June 2007
Overview of presentation
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Background
Progress in implementation of TB/HIV
activities
Scale up plan from March 07 meeting
Plus up activities
Outstanding issues
Background information
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Zambia
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TB Program (current)
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Population – 11 million
9 provinces, 72 districts
National Unit – Manager, 2 program officers
Provincial TB focal person
District TB/Leprosy focal persons
New Structure
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5 staff in central unit,
Provincial level – integrated in Communicable disease unit
District TB/Leprosy Focal persons
Progress in implementation of
TB/HIV activities
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Establish mechanism of coordination
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TB/HIV coordinating body at all levels
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Surveillance of HIV in TB patients
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Data will be obtained from routinely collected data
Joint TB/HIV planning
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National body – √
Provincial and district – TOR developed
Not yet happening, HIV program officers (ART, VCT,
PMTCT) part of coordinating body
Conduct monitoring and evaluation
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Registers have HIV data (HIV status, ART, CTX)
Progress in implementation of
TB/HIV activities
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Reduce burden of TB in PLWHA
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Establish intensified case finding
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Introduce IPT
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TB symptom screen part of ART eligibility and follow up.
Not accepted as public health intervention, pending
results of Botswana experience.
Ensure TB infection control in health care and
congregate settings
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Plan to develop guidelines
Progress in implementation of
TB/HIV activities
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Reduce the burden of HIV in TB patients
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Provide HIV counseling and testing - PICT
introduced as standard of care
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Introduce HIV prevention methods - Plans
included in 2006 – 2011 TB National Strategic Plan
Introduce cotrimoxazole- Variable included in
revised registers, guidelines not distributed, supply
chain not addressed
Progress in implementation of
TB/HIV activities
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Ensure HIV care and support
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Links exist with HBHC providers , but needs to
be strengthened
Introduce ARV therapy
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Guidelines for ARVs in TB patients developed,
referrals occurring and reported in TB register
Achievements
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PICT manual developed
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TB recording and reporting forms revised and
in use since 2nd quarter 2006
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50 trainers trained
Close to 500 health workers trained in DCT
All districts reporting TB/HIV data
TB/HIV data reviewed as part of TB review
meetings
Scale up plan for TB/HIV
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USG/WHO/Gates meeting March 2007
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Reference document
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Zambia Team – National ART coordinator, head of TB NRL,
USG focal person
2006 -2011 National TB Strategic Plan
TB/HIV guidelines
National Laboratory plan
Vision
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Diagnose and treat HIV infection in all TB patients
Diagnose and treat active TB in all HIV infected settings
Prevent TB transmission in health care settings
Brief outline of scale-up plan
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Areas covered include
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Policy,
Training,
Supply chain management,
Laboratory,
Physical infrastructure,
Human resources
Supervision and M&E
Process followed
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Meeting with National TB Manager
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Report provided to PEPFAR team
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Plan discussed and accepted
Briefing of TB/HIV coordinating body
TB/HIV working group
Planning for Plus-up funds
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National program, USG
PEPFAR supported partners in
TB/HIV
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JHPIEGO
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CIDRZ
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Lusaka Province, TA to 3 Provincial Health Offices
FHI/Zambia Prevention Care and Treatment
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Development of training materials, guidelines, ToT
Zambia Defense Forces
5 northern Provinces
CARE International
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DCT, community linkages, IEC
PEPFAR supported partners in
TB/HIV
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CRS/AIDS Relief
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Provincial Health office
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National coordination and supervision
SHARE
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4 southern provinces
Ministry of Health
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Faith based and private institutions
GDA – mining and agribusiness
Churches Health Association of Zambia
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Faith based institutions
Activities included in Plus-up
funds
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Policy
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Funding provided for printing and distribution of
HIV guidelines, training materials for DCT
development of Infection control guidelines
Training
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ToT in PICT
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3 trainers per district, including the ZDF
Health staff
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DCT
ART/OI management
TB diagnosis and management for ART service providers
Activities included in Plus-up
funds
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Training (cont)
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Lay counselors/peer educator
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Cross referrals between TB and ARV program
Training counselors
Increase community involvement, IEC
Evaluation of smear negative/EPTB
guidelines
Activities included in Plus-up
funds
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Supply Chain Management
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Procurement of HIV test kits, CD4 reagents
and biochemistry reagents
Laboratory
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Improved laboratory equipment,
infrastructure
Use of low cost fluorescence microscopy
Strengthen national EQA system
Activities included in Plus-up
funds
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Physical Infrastructure
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Human resource
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Renovations to provide conducive environment and reduce
risk of infection
National Technical Advisor for EQA
TB/HIV officer at central level (COP07)
Supervision and M&E
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Technical Support supervision at all levels by national
program
Mentoring and TA by implementing partner to districts
Improve data collection using national forms, data review
meetings
Outstanding issues – COP08
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Cotrimoxazole
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Distribution of guidelines, training of staff
Supply management, tracking
Strengthened linkages between TB and
HIV services
TB screening for PLWH
Infection control
IEC
Other support for TB activities
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TB CAP
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Global Fund
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Support for TB control including TB/HIV in
3 provinces ( will scale up to 5 provinces)
Support for strengthening TB DOTS
KNCV/CIDA
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National and provincial level support, will
support Data Officer in central unit